AtriCure (NASDAQ:ATRC) CFO Angie Wirick outlined the company’s early expectations for 2026 growth and discussed product adoption trends across its cardiac surgery and pain management franchises during an appearance at the Citizens Life Sciences Conference.
Initial 2026 outlook: 12% to 14% organic growth
Wirick said the company’s initial 2026 organic revenue growth guide of 12% to 14% represents a “slight uptick” from what AtriCure guided at the start of 2025. She attributed the outlook to continued momentum from recent product launches across the company’s key areas, with the strongest expected contribution coming from pain management.
- Pain management to outpace other franchises, supported by newer products and still-low penetration in thoracic procedures, plus a newer amputation-related opportunity.
- Open cardiac surgery tools (ablation and appendage management) to benefit from continued adoption of the EnCompass clamp and newer AtriClip products, with appendage management expected to be roughly in line with overall company guidance.
- Hybrid/standalone atrial fibrillation (Afib) treatment to remain a headwind, though with a smaller decline than in 2025.
Open ablation: EnCompass clamp broadens addressable adoption
Discussing the EnCompass clamp, Wirick said the device has helped simplify a procedure that historically took about 30 to 45 minutes down to about eight to 10 minutes. She said that reducing procedure time has been a key driver of adoption, particularly in coronary artery bypass grafting (CABG), where concomitant Afib treatment had historically been less common.
Wirick described cardiac surgery as consisting primarily of mitral valve, aortic valve, and CABG procedures. She said AtriCure historically saw the highest concomitant Afib treatment penetration in mitral valve surgery, while adoption in aortic valve procedures was lower, roughly in the 40% to 50% range. In CABG, she said penetration was “less than 10%” prior to EnCompass, despite CABG representing the largest portion of the cardiac surgery market.
She added that most of the growth in AtriCure’s open heart business has been driven by CABG surgeons, and estimated that as the company exited 2025, CABG penetration in the U.S. was around 20%.
Pain management: faster procedures driving adoption, reimbursement remains a headwind
Wirick said AtriCure’s pain management growth has been supported by product iterations aimed at reducing procedure time. She described surgeon feedback on the company’s cryoSPHERE platform as highly positive on clinical impact, but said time required to freeze multiple nerves could be a barrier. According to Wirick, earlier versions involved about two minutes per nerve, which could add 25 to 30 minutes to a procedure.
She said newer products were developed to speed up use in the operating room, describing successive improvements that reduced freeze time per nerve, including a version that cut the time to about one minute per nerve. Wirick characterized this as a compelling reason for surgeons to adopt the technology more broadly.
On potential gating factors, Wirick said reimbursement remains a headwind because the technology can represent an additional cost in a procedure, and she said AtriCure has been working to build data “from a lot of different angles” to support reimbursement. She added that, for the company’s newer pain management products, she did not see major barriers to adoption and described it as a “pretty easy switch” for many surgeons.
On competition, she said cryoanalgesia is not new and noted the presence of competitors outside the U.S., though she said they have not had “great success” so far. She also emphasized the capital investment needed to enter the space, including generator placement across accounts to support disposable utilization.
New pain indication: cryoXT targets post-amputation pain
Wirick discussed the company’s entry into post-operative amputation pain management with a dedicated device, describing a U.S.-focused opportunity tied to an estimated 180,000 amputations annually, including about 100,000 to 110,000 lower-limb procedures. She said the overall number of amputations is growing, particularly in patients with vascular disease and diabetes.
She said the move into amputations was sparked by surgeon experience, with thoracic surgeons using AtriCure’s pain management device alongside general surgeons and observing potential benefits in amputation cases, where large nerves are exposed. Wirick said AtriCure developed a dedicated device with a differentiated tip designed for severed nerves, allowing a nerve to be wrapped around the device for freezing. She said early results have been “excellent,” noting that amputation procedures involve freezing a couple of nerves per case.
Appendage management: AtriClip FLEX-Mini and PRO-Mini adoption, competition seen as validation
Wirick said the company’s AtriClip appendage management franchise benefited from the launch of AtriClip FLEX-Mini, describing it as a smaller-profile device that provided surgeons comfort about avoiding contact with adjacent structures. She said the product’s ramp in 2025 “surprised” the company to the upside, even though initial expectations were for a “slow and steady” adoption curve.
She said most growth in the franchise remains volume-driven, though the new product launch also contributed to average selling price (ASP) uplift. Wirick added that a key objective of R&D investment is to drive ASP uplift and gross margin improvement, and said the market has validated pricing for the newer device. She noted that many of the conversions were from surgeons already using the prior AtriClip FLEX-V device.
On minimally invasive appendage management, Wirick discussed AtriClip PRO-Mini, saying it brings the smaller profile benefits into closed-chest hybrid procedures where visibility and a low-profile device are important. She said conversion to PRO-Mini has been good and provides ASP uplift, but that overall growth depends on underlying procedure volumes. Given expectations for continued pressure in the hybrid business in 2026, she said ASP could potentially bring the minimally invasive appendage management area to “around flat,” but the company’s expectation is a decline.
Addressing a recent competitive entrant in appendage management, Wirick said AtriCure views competition as validation of the market opportunity. She emphasized AtriCure’s continued investment in innovation and clinical science as key differentiators, and suggested broader industry participation could support the long-term vision that appendage management becomes standard for cardiac surgery patients.
Hybrid Afib treatment: PFA headwinds persist, but signs of stabilization
On the company’s hybrid Afib treatment business, Wirick said pulsed field ablation (PFA) has become first-line therapy for many electrophysiology (EP) practices, creating a headwind for AtriCure. She said current revenue contribution tends to come from accounts that first adopted PFA broadly, then saw multiple failures and began looking for alternatives for advanced patients.
Wirick said AtriCure’s CONVERGE procedure is positioned for patients with long-standing persistent Afib and other advanced cases where a more durable option is needed. She pointed to “green shoots” in the U.S., noting sequential growth from the third quarter to the fourth quarter that reversed a roughly two-year trend, but said the company would look for multiple quarters of stability before projecting growth. For 2026, she said AtriCure still expects a decline in hybrid, but less than in 2025.
Internationally, she said PFA adoption in Europe coincided with the company’s CONVERGE trial data, initially making it difficult to start centers. Over time, she said some European physicians observed PFA failures and moved toward establishing CONVERGE programs, contributing to “really good growth” in Europe, though she noted some pressure in the U.K. in the back half of 2025.
Clinical trials: LeAAPS and BoxX-NoAF targeting non-Afib cardiac surgery patients
Wirick highlighted two clinical efforts aimed at expanding treatment in non-Afib cardiac surgery patients. She said about 2 million patients undergo cardiac surgery annually, and about 30% have a preexisting Afib diagnosis. The LeAAPS trial is focused on the remaining 70% without an Afib diagnosis, representing what she called a “massive market opportunity.”
She said LeAAPS enrolled 6,500 patients, which she described as the largest cardiac surgery trial. Enrollment began in January 2023 and completed in July 2025, about two years faster than anticipated, which she attributed to high investigator interest, with more than 500 surgeons participating. The trial is event-driven, and she said the company had reached the 50% mark toward required events as of its most recent quarterly update.
Wirick also discussed the BoxX-NoAF trial, which targets the same non-Afib population and addresses postoperative Afib, a complication she said can occur in up to 50% of patients depending on the primary procedure. She said enrollment has been strong, leveraging many of the same sites as LeAAPS, and she indicated AtriCure believes results will support broader benefits of treating cardiac surgery patients regardless of preexisting Afib status.
About AtriCure (NASDAQ:ATRC)
AtriCure, Inc is a medical device company focused on the development, manufacture and marketing of innovative therapies to treat atrial fibrillation (AF) and related conditions. Founded in 2000 and headquartered in Mason, Ohio, AtriCure has established itself as a leader in surgical ablation devices designed to interrupt the errant electrical pathways that cause AF. The company’s solutions are used by cardiac surgeons and electrophysiologists to reduce the risk of stroke and improve patient outcomes in the treatment of both paroxysmal and persistent AF.
The company’s product portfolio centers on its Synergy Surgical Ablation System, which delivers controlled radiofrequency energy in a minimally invasive format, and the cryoICE Cryoablation System, which offers an alternative ablation modality using precise freezing techniques.
